護理之家之機構主管對照護品質指標認同觀點之研究-以中部地區為例

A Study of the Nursing Home Managers’ Aspect among Care Quality dicators - an example of the central Area in Taiwan

林京慧(CHINGHUI LIN)

指導教授 ： 張庭彰 ； 張育嘉

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2009年)

摘要

摘 要
背景：台灣自1993年9月正式步入高齡化社會，截至2009年5月，國內的老年人口達總人口的10.51%，約242萬人；而扶老比14.44%，老化指數62.89%，均較去年同期成長。因人口結構高齡化、疾病型態慢性化、家庭型態轉變、婦女就業率提高、身障者逐年攀升，對「長期照護」需求愈益迫切，相形之下具備專業照護之護理之家，更顯得重要。因此，護理之家照護品質值得重視。
目的：本研究旨在建立護理之家照護品質指標基本架構，試圖瞭解主管對於照護品質指標構面及其重要性看法並探討機構特性及主管特性背景變項影響照護品質項目重要程度的顯著因素，以供各界參考。
方法：本研究以督導考核指標項目為研究工具，以自擬結構式問卷，針對護理之家主管調查，以SPSS 12.0進行因素分析（Factor Analysis）萃取不適合因素，降低變數個數，縮減為少數具代表性關鍵因素，參考組成該因素因子題意予命名後，以立意取樣方式進行問卷調查。回收問卷後，採描述性統計、ANOVA變異數分析對基本資料、照護品質構面看法之分佈、排序及顯著因素分析。
結果：
一、照護品質指標重要性排序前三名依序：(一)經營者等主管：住民安全構面中緊急呼叫設施維護與管理、感染控制及行政管理構面中工作人員管理；(二)護理部門主管：整體環境構面中氣味(異味)及住民安全構面中緊急呼叫設施維護與管理、急救等相關設施設備；(三)照顧服務部門主管：整體環境構面中氣味(異味)及住民安全構面中緊急呼叫設施維護與管理、感染控制、照護計畫。
二、影響主管認為照護品質重要程度的顯著因素有主管職務別。
三、背景特性與照護品質的顯著因素有機構型態、規模、屬性。
結論：
一、本研究建立護理之家基本照護品質指標架構，可包括五大構面「行政管理」、「住民安全」、「服務內容」、「整體環境」和「加減分」等；及17個子構面為：工作人員管理、住民權益、通報管理、相關設施設備、人員急救訓練、感染控制、空調設施維護與管理、緊急呼叫設施維護管理、用藥管理、飲食照顧、社交休閒活動、專業會診、照護計畫、舒適度、氣味、加分項目、減分項目等。
二、對照護品質指標重要程度之前三名排序中，護理之家主管均認為「住民安全」構面中的「緊急呼叫設施維護與管理」很重要，而「屬性」公立護理之家主管較其他護理之家主管覺得「住民安全」重要。
三、對於照護品質項目之重要程度前三名排序，經營者等主管認同「住民安全」、「行政管理」重要性大於「整體環境」、「服務內容」、「加減分」構面；護理部、照服部門主管認同「整體環境」、「住民安全」重要性大於「行政管理」、「服務內容」、「加減分」構面。
四、研究發現機構特性中，「型態」與照護品質之「行政管理」、「住民安全」、「服務內容」有顯著，進一步分析「型態」為醫院附設之主管認為此項重要性較「型態」為獨立型之主管高。
五、研究結果發現，護理之家主管「職務」影響認同品質之重要程度。護理之家各主管均一致認同「行政管理」、「住民安全」、「服務內容」、「整體環境」等項目，惟「加減分」中的「減分」項目較「加分」平均得分較低，顯示各主管認為「減分」項目重要性較低。
六、本研究結果雖有各主管對於評估指標的重要性排序，可供機構參考優先建置用，但為提昇護理之家照護品質，機構仍以滿足住民個別化的身、心、靈照護需求，維護尊嚴與自主為原則。
七、建議照護品質各評量子構面，有不同的配分評量比例或權重，以適當反應品質。

關鍵字

護理之家 ； 照護品質

並列摘要

Abstract
Introduction:
The society in Taiwan has entered into the aged society since 1993 in September. The aged population has reached to 10.51% (2.42 million) compared to total population in Taiwan by May, 2009. The proportion of supporting each old person is approached to 14.44% and indicators of ageing is 62.89%, which gets more growth comparing to the same period of time. Due to the ageing problem, chronic diseases, family style changes, ratio of career women and the disabled raised, the need for long-time care is dramatically ascending. Thus, the nursing home with professional caring license are becoming more and more importance, i.e. the quality of these homes should be placed emphasized on.

Purpose:
The purpose of the study is to create the quality indicators of nursing care for nursing home . We attempted to investigate the opinions of nursing home managers toward nursing quality and correlation between background data and caring items, which will be reference offered to industries, government and academic field.

Method:
The questionnaire was self made structurally. The subjective of the study is focused on the nursing home managers located in the central Taiwan. Factor Analysis, ANOVA and related correlation are utilized with software, SPSS 12.

Result:
1. The top three indicators of caring quality are: (1) Managers of administration indicate the maintenance and management of emergency calling facilities and infection control in citizen dimension, as well as staff management in administration dimension; (2) Managers of nursing departments indicate the control of fragrance in overall setting dimension and the maintenance as well as management of emergency calling facilities and emergency facility in citizen dimension; (3) Managers of nursing care department indicate control of fragrance in overall setting dimension and the maintenance as well as infection control, caring plan, management of emergency calling facilities and emergency facility in citizen dimension.
2. The result shows that the position of manager is an important factor affecting nursing quality.
3. The statistical factors of background data and caring quality include institution type, scale and features.
Conclusions:
1. The caring quality indicators of nursing homes are created in the study including five dimensions: administration, citizen safety, service content, overall settings and bonus and deduction point. 17 sub-dimensions includes staff management, citizen rights, announcement management, relevant facilities, staff first aid training, infection control, maintenance and management of air conditioners, maintenance and management of emergency calling facilities, medicine management, diet caring, social activity, consultation, caring plan, comfortability, fragrance, bonus point and deduction point.
2. Among the top three caring quality indicators, the managers of nursing home all believe that the maintenance and management of emergency calling facilities in the citizen safety dimension is very important. However, managers in the public nursing homes think the citizen safety is more important than those in other nursing homes.
3. Among the top three caring quality indicators, managers of administration think that citizen safety and administration are more essential than overall setting, service content as well as bonus and deduction points. Managers in nursing and caring service departments all think that dimensions of overall settings and citizen safety are more important than administration, service content as well as bonus and deduction point.
4. The finding of the result shows that in terms of the feature of the institution, administration, citizen safety and service content of the type and caring quality are statistically different, i.e. the managers of hospitals all think so.
5. The position of manager would affect the quality identification. The managers in nursing homes all agree that administration, citizen safety, service content and overall settings; however, the deduction items comparing to the bonus items got lower average, which mean that the managers that the deduction items are not important.
6. The finding shows that although the importance rating of quality indicators by managers can be referred by institutions, in order to promote the caring quality of nursing homes, they would adopt to meet the need of citizen and their spirit as well as dignity and liberty.
7. We suggest that giving each sub-dimension of the caring quality indicators with proper scoring or weight, which would reflect its importance appropriately.

並列關鍵字

nursing home ； care quality

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